Good morning to all (or whatever time it is for you when you are  
reading this in your corner of the world!),

I have been following the message thread about breastfeeding in the  
military, and now the justification for BFHI in military hospitals,  
with great interest.  My story is sort of long, but I'd like to share  
it here if you are interested.

Most of you know I am a mother on active duty in the U.S. Army,  
myself.  My story is this: I got pregnant and gave birth to my first  
baby in 2002, after 7-1/2 years of service.  I wanted desperately to  
separate at that time (any enlisted mother can make a case for  
"hardship" anytime after she gives birth, even if she signs the  
counseling form at 20 weeks committing to stay on active duty)  but my  
husband told me flat out that my not working didn't fit into his  
vision for our family.  Knowing that I could either honor my marriage  
or be a single mother (who would still have to work outside the home),  
I found myself going back to work when my baby was 3 months old, with  
a broken heart and many questions about life in general (which, 7  
years later, are coming to a head but that is a whole other story).

The Army does not give "maternity leave;" it gives "convalescent  
leave."  This is an important distinction.  The Army gives 42 days  
after a vaginal or surgical birth so that a woman can "physically  
recover" and return "fit for duty."  Any of us who has given birth  
knows quite well that 6 weeks doesn't really amount to much after  
giving birth.  Nor does 180 days, which is the next big milestone for  
a mother returning to active duty; that is when the first required  
fitness test and weigh-in can be administered.  I can safely say the  
stress caused by having to lose weight and demonstrate fitness (push- 
ups, sit-ups, and a 2-mile run) at 6 months postpartum was  
monumental.  I have 2 co-workers who believed breastfeeding would  
complicate their ability to achieve this requirement and weaned their  
babies at 6 weeks.  (Yes I am hoping you all can see where support is  
necessary and possible for these mothers ... such as being able to  
encourage them that they CAN exercise and breastfeed.)

I did as Gloria suggested - I saved up regular leave time before and  
during my pregnancies, which yes, means, I often worked for a year  
straight with no rest or relaxation from my job in order to have  
enough days saved up to stay with my babies.  I went back after 3  
months for each of them (I have 3 children), and I also planned my  
pregnancies such that I would be returning to work during "slower  
seasons" in our year.  I am a musician in a special Army band (not to  
be confused with the bands that are attached to divisions or major  
commands).  My first several months back each time, I managed to limit  
my separations to 15-20 hours/week for the next 3 months.  THis was  
accomplished by my taking work home and doing it when the baby napped  
in the sling or, as I had more children, after everyone had gone to  
bed at night.  So, I was going to bed late, nursing my babies through  
the night, and going to work in a relatively challenging (mentally)  
job.  I continue to be surrounded by young people, fresh out of their  
master's degrees in clarinet performance, who think I don't belong in  
my seat anymore, and make that abundantly known to me.  I don't have 3  
hours a day to practice anymore.  I'm lucky when I can find an hour, 4  
days a week, beyond my rehearsal time.

My assignment is a unique one, we do not deploy nor do we get regular  
reassignments every few years like most members of the military.  This  
has been both a blessing and a curse.  We do not deploy, but since I  
had my children we have taken several trips, some extended, to perform  
in various places around the country.  My struggle hasn't been whether  
or how to leave my babies for a year or more, but it has been how to  
find people to accompany me on trips so that I could keep my babies  
with me.  We do not live near family and since my husband is also in  
the band, we don't have much time to socialize and meet other people  
outside of our workplace (we work on the usual "barbecue holidays"  
like 4th of July and Labor Day and Memorial Day, etc.).  I got tired  
of needing one caregiver in my home for rehearsals and having to find  
others who could travel with us, sometimes during the week, sometimes  
on holiday weekends, sometimes by car, often by plane.  The expense  
was great.  I finally decided to have an au pair live in our home,  
which again was terrific for the children who got to have one  
caregiver who lived in our home and was an extension of mamma or  
daddy, but it has been hell on me having another young person in my  
home to take care of and manage.  It has also required that I take a  
job with the au pair agency so that we could afford this childcare  
solution!  (My husband and are both E-7's.  Go ahead and look up what  
we earn in a year.  It isn't much.)  I am currently in my final month  
in that 2nd job because, due to chronic lack of sleep, chronic  
sadness, frustration, and anger, my health is not optimal.  We also  
don't have the benefit of a new assignment every few years, with new  
people and fresh starts.  We are stuck with the same people who  
remember every move you've made for the last 15 years.

I breastfed my first child to age 3y8m.  My second child weaned at  
3y10m.  My baby, at almost 26 months old, is still nursing and I hope  
with all my heart she never stops since she will be my last baby.  A  
lot of my nursing months were tandem ... 22 months after my 2nd child  
was born and 8 months after my 3rd was born.  I am unsure about  
whether my husband and I will be married for much longer but I am  
desperate to create a situation whereby my children have access to  
both of us.  He has been a bad husband but a very good father.  He  
sees the error of his ways now that my physical and emotional  
deterioration have become "clinical" and I'm under a doctor's care.

I believe I am the only IBCLC on active military duty in the U.S. Army  
(even though I am, as yet, not working at all as an IBCLC other than  
to write articles and present sessions at conferences).  There are  
IBCLCs at military hospitals, but I don't believe any of them are on  
active duty.  They are civilians.  My life's dream is to have a  
position created for me in the military.  I want to educate healthcare  
providers, to travel to every Army hospital/clinic in the system and  
spend some time building their breastfeeding support programs, and  
ultimately have the Army lead the U.S. in progress toward a completely  
BFHI-compliant hospital system.  I have a few physicians interested in  
my proposal but I am still working to make that proposal irresistible  
and a "must-have" in the eyes of the big decision-makers.  I have been  
asked to do a grand rounds day at our Army hospital this spring, where  
I will spend the day with the Family Medicine staff and talk about  
lactation, breastfeeding, and how to support mothers both serving and  
married to servicemembers.  Both parts of our community have unique  
challenges that are not experienced by civilians.

I tell my story because I realize there are many people who believe I  
have "made it work" and I "have it all."  I won a position in an  
extremely competitive field in 1995 and have maintained it, for what  
it's worth, while also mothering in an attached manner and  
breastfeeding 3 children.  My career has not progressed as it might  
have had I not been the type who asks forgiveness instead of asking  
permission (and I wouldn't change a thing about the choices I made  
within the framework I was dealt).  There were supportive and not-so- 
supportive members of my chain of command over the years.  The not-so- 
supportive ones took great exception to the fact that I stood up for  
myself and did what was best for my babies even if it seemed  
unconventional.  I had one XO (Executive Officer - 2nd in command) try  
to tell me it was "illegal" to bring my baby on an overnight trip.  I  
knew he had nothing to stand on and I told him as much, then told him  
that if he tried to issue a direct order that I not bring my child, I  
would challenge him to stop my mother from vacationing at our  
destination and staying in the same hotel and bringing my baby along  
for HER trip.  I think smart women with strong wills are going to have  
a hard time no matter where they function in our current society  
(United States) but I am doing all I can to teach my own daughters to  
stand up for what they know is right and to always put people before  
things (ironic that I have no trouble with this at work but struggled  
with it at home).  My son is learning to be sensitive and advocate for  
what is right, as well.  I continue to receive outstanding NCOERs (our  
annual performance evaluation), awards for service and impact, and I  
contribute in significant ways at my job ... I just often make my  
contributions from home, at 11:00 at night when the chores are done  
and everyone is asleep.

I am here to tell you that, in my situation, I believe no one wins.  I  
suffer daily heartbreak that I did not mother my children as God  
intended me to.  I did all I possibly could to minimize the impact of  
my separations on my babies, and I also took great care to minimize  
those separations at all.  Even now that they are older and in school  
(the first two), my heart breaks that I am not the one dropping them  
off and picking them up.  I chaperone whenever my job allows me to be  
absent but I don't feel as involved in their lives as I'd like to be.   
I'm tired.  Bone tired, all the time.  Every minute of every day, I'm  
tired.  I know this is part and parcel of being a mother but if I may  
say so, I think for me, there is the additional component of feeling  
emotionally overwrought on top of the physical exhaustion.  My husband  
has felt resentment because his formerly self-sufficient, independent  
wife developed needs for support and that detracted from his career  
aspirations.  I have trouble feeling sympathetic after he forced me to  
stay in a career that requires a singular focus that I really had no  
heart for anymore.  I go through the motions, I perform my duty, but  
my heart is at home.  I have over 5 years left until I can retire and  
I am one of those women who counts the days.  My children will be 12,  
10, and 7 when I am done.  I pull out every stop when I am with my  
children to still be their "home base" and maintain a physically  
close, high-touch relationship with all three of them.  My older two  
don't nurse anymore but love to snuggle up to me after I've slept in  
pajamas and "smell mamma's sleep."  They both remember nursing and  
talk about how great it was.  They are compassionate and in touch with  
their feelings.  I continue to encourage them to express themselves in  
effective and constructive manners, which I believe is at the very  
core of breastfeeding.  I could write an entire dissertation about how  
breastfeeding is the basis of all communication and feelings from  
birth to death because I believe in my heart that nursing them as I  
did, for as long as I did, is a huge factor in everything else that  
followed in my mothering.  When other parents at our job were going  
out after concerts because "the kids are asleep anyway and the sitter  
doesn't mind a few extra hours of pay," I rushed home to snuggle into  
bed with my kids so that they could make up the nursing we missed at  
bedtime (I'm not talking about an infant here ... the infants were  
always with me on site).

Anyway, I'd like to say that I agree with Nina that the system is  
grossly flawed if the proper care (my faith tells me that God created  
a perfect bodily system that governs everything from pregnancy, birth,  
breastfeeding, and beyond if we just listen to our bodies - some might  
say this is "nature" or an "organic" way of doing things but for me it  
has been about recognizing and honoring God's will ... I accept that  
others will see the root in a different place but I think we  
ultimately all believe the same things about mother/baby togetherness  
being part of that perfect system) of babies is not the very first  
priority of that system, because everything flows from that care and  
protection of those who cannot speak for themselves.  I also hear  
Robyn loud and clear when she says the situation is what it is and  
we've got to work within the framework we're given to offer support  
and ultimately, hopefully, make small changes every day that lead to  
bigger changes.

All of my ramblings do have a significant point and if you're still  
with me at this place, thank you for reading and I hope what I have to  
share is helpful to you as you support mothers and their babies in  
breastfeeding.  Why is the BFHI important in a military setting?   
Because in the military, everything, and I do mean EVERYTHING is based  
upon the recognition of authority.  If the medical side embraces the  
BFHI, it sets the tone for everything that follows.  In the military,  
commanders/supervisors are at the mercy of physicians/healthcare  
providers.  When I was developing mastitis, and a DOCTOR wrote a note  
saying I needed to have 72 hours "in quarters" to rest and be with my  
baby, I got the time off to take care of myself (and the mission was  
protected because I wasn't debilitated/sick 5 days later when the  
performance was, and I always practiced my parts when I missed a  
rehearsal so I was prepared to contribute).  If the military embraces  
breastfeeding as important and as a bottom line, so much of the  
support we have to give won't be necessary anymore.  If breastfeeding  
is considered the norm, it won't seem like mothers are getting  
something for nothing if breastfeeding is encouraged and supported.   
The BFHI establishes that breastfeeding is the next step in the  
biological sequence of pregnancy and birth.  The military is on its  
way to embracing that pregnancy is a self-limiting situation, but  
isn't eager to extend the time of that limitation by encouraging  
breastfeeding (they still haven't realized that a baby who was  
breastfed grows into a child who doesn't need to miss school as often  
because of stronger overall health and immunity, etc.).  Like I said,  
I have navigated my own course such that I get what I need; a place to  
pump or nurse wherever we are, an appropriate space on-site for my  
baby to be with a caregiver while I'm on stage, separate travel  
arrangements from the rest of the band so that I can more easily bring  
my 2-year old on a trip to Texas in February ... I've asserted my  
needs, promised and delivered the "product" of good job performance,  
and won the support of enough people in charge that other mothers  
following behind me are able to work similar situations in favor of  
balancing.  It is not ideal or perfect but for the mother who chooses  
or is coerced into keeping her career, it is a big step in the right  
direction.  BFHI-compliance in the military would set the groundwork  
for breastfeeding as the norm, not as "extra credit" as so many people  
seem to believe it is.  It is one tool that would yield a huge bang  
for a small buck, so to speak.  The system has to support the truth  
and currently, it does not.

One more thing, Jeanette, there is a military hospital that has become  
Baby-Friendly, and another that was but no longer has a mother/baby  
ward so still is recognized for having gone through the process.

I know this has been long and I appreciate those of you who have  
chosen to read the whole message I am trying to send.  I'm not sure I  
adequately communicated everything I hoped to, I started this message  
more than 5 hours ago but between cleaning up breakfast, getting  
little people dressed, nursing the little one (or just holding her  
when she says "Mamma, YOUUUUU!"), etc. I'm sure I worded something or  
poorly expressed a thought or feeling ...

--Diana Cassar-Uhl
IBCLC, LLLL, and mother of 3 on active duty in the U.S. Army (as a  
Sergeant First Class/clarinetist/Education Outreach Non-Commissioned  
Officer in Charge)
dreaming of an opportunity to leave music behind in order to educate  
healthcare providers and policy-makers for as long as it takes!

             ***********************************************

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